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Section: Interventional Radiology

 




Other Radiology articles from the Interventional Radiology section Interventional Radiology

Acute-phase endovascular management of an uncommon bleeding peripancreatic pseudoaneurysm by Marco Varrassi et al.

Published: 2018 May
Issue: 12(5) :: Pages: 12-18


Free full text article: Acute-phase endovascular management of an uncommon bleeding peripancreatic pseudoaneurysm

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Abstract: Pancreatic pseudoaneurysms represent relatively rare but potentially lethal complications of acute or chronic pancreatitis, involving several visceral arteries. Due to their intrinsic instability and subsequent high risk of massive bleeding, these lesions require prompt treatment, regardless of the size of the pseudoaneurysm. First option of treatment is today represented by transcatheter embolization; this treatment, in fact, shows higher rates of clinical and technical success and lower recurrence rates than conventional surgery. We present a clinical case of endovascular management of a large pseudoaneurysm, measuring 54 x 53 mm (AP x LL), involving right gastric artery in a 35-year-old woman with history of chronic alcoholic abuse presenting with severe anemia.


Available image modalities: (click on modality to browse for other articles)
Computed Tomography, Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Thrombogenic superior vena cava syndrome from long-standing central venous access in a 5-year-old patient treated with balloon-expandable stents by Dabin Ji et al.

Published: 2018 Apr
Issue: 12(4) :: Pages: 15-22


Free full text article: Thrombogenic superior vena cava syndrome from long-standing central venous access in a 5-year-old patient treated with balloon-expandable stents

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Abstract: Thrombogenic superior vena cava syndrome is an uncommon, dangerous complication of long-standing central venous catheter use. The increased use of central venous catheters has resulted in more non-malignant cases of superior vena cava syndrome across all age groups. We present a 5-year-old male with superior vena cava syndrome associated with acute onset of severe upper extremity and facial swelling, dyspnea, and a right subclavian central venous catheter malfunction. The patient was ultimately treated with percutaneous stenting of the superior vena cava with balloon-expandable Palmaz stents following unsuccessful angioplasty, catheter-directed thrombolysis, and percutaneous thrombectomy. This case highlights a relatively uncommon complication in children from long-term central venous catheter access and describes an emerging, minimally-invasive therapeutic alternative that allows for preservation of age-appropriate superior vena cava luminal diameter as patients grow.


Available image modalities: (click on modality to browse for other articles)
Ultrasound, Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Endovascular retrieval of Greenfield IVC filters 13 and 19 years post placement without major complication by Junjian Huang et al.

Published: 2017 Jun
Issue: 11(6) :: Pages: 15-25


Free full text article: Endovascular retrieval of Greenfield IVC filters 13 and 19 years post placement without major complication

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Abstract: Inferior vena cava (IVC) filters were first introduced in 1967 by Kazi Mobin-Uddin and later improved by Lazar Greenfield in the 1980s becoming a major component of catastrophic pulmonary embolism prevention. Nevertheless, filters are not entirely harmless. The long term risks include caval thrombosis, visceral penetration, and filters can serve as a nidus for infection. Filter retrieval is often complicated by intimal hyperplasia especially with increased indwelling time. Historically, Greenfield filters in place for longer than 3 weeks were considered permanent due to the risks of retrieval. Herein we present 2 cases of successful retrieval of Greenfield filters 13 and 19 years post implantation.


Available image modalities: (click on modality to browse for other articles)
Clinical image, Computed Tomography, Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Image-guided Percutaneous Transhepatic Removal of Fish Bone from Liver Abscess by Chin Wah Lau et al.

Published: 2017 Feb
Issue: 11(2) :: Pages: 1-7


Free full text article: Image-guided Percutaneous Transhepatic Removal of Fish Bone from Liver Abscess

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Abstract: We present a case of a woman who was diagnosed with a hepatic abscess secondary to a migrated fish bone. As the patient did not improve after percutaneous drainage of the abscess, image-guided percutaneous transhepatic removal of the fish bone was performed. Fish bones in hepatic abscesses are typically removed surgically, with the fish bone left in situ in a number of cases. There has been only another reported case of percutaneous transhepatic fish bone removal. We conclude that in the rare case of a hepatic abscess complicating fish bone migration, image-guided percutaneous transhepatic removal of the offending foreign body is a feasible alternative to surgery, especially in high surgical risk patients.


Available image modalities: (click on modality to browse for other articles)
Computed Tomography, Angiography, Interventional, Macroscopic pathology, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Lateral Thoracic Artery Pseudoaneurysm as a Result of Penetrating Chest Trauma by Matthew Pontell et al.

Published: 2017 Jan
Issue: 11(1) :: Pages: 14-19


Free full text article: Lateral Thoracic Artery Pseudoaneurysm as a Result of Penetrating Chest Trauma

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Abstract: Pseudoaneurysms are potentially fatal complications of vascular trauma; however, they are rarely seen as the sole complication of penetrating injury. We present a case of a pseudoaneurysm with an associated arteriovenous fistula of the left lateral thoracic artery as a result of direct trauma from a knife stab. The patient presented only with a painful, swollen left pectoralis muscle. Upon diagnosis, he was taken to the interventional radiology suite and treated successfully with fluoroscopic guided coil embolization. Cases such as these are infrequent and should encourage more aggressive use of contrast enhanced computed tomography imaging for soft tissue injury, as a missed traumatic pseudoaneurysm may result in life-threatening hemorrhage.


Available image modalities: (click on modality to browse for other articles)
Computed Tomography, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Percutaneous Cholecystostomy and Hydrodissection in Radiofrequency Ablation of Liver Subcapsular Leiomyosarcoma Metastasis Adjacent to the Gallbladder: Protective Effect. by André Azevedo et al.

Published: 2016 Oct
Issue: 10(10) :: Pages: 24-32


Free full text article: Percutaneous Cholecystostomy and Hydrodissection in Radiofrequency Ablation of Liver Subcapsular Leiomyosarcoma Metastasis Adjacent to the Gallbladder: Protective Effect.

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Abstract: Uterine leiomyosarcoma is an uncommon pathology, predominantly found in aged population. Patients with metastatic disease have poor survival and therapy mainly consists of palliative systemic chemotherapy. However, more aggressive strategies such as radiofrequency ablation (RFA) may benefit patients with limited secondary disease. RFA is considered a simple and safe modality for treatment of hepatic lesions. The benefits related to RFA include low morbidity, short hospital stay and the possibility to repeat the procedure when necessary due to recurrences. However, minor and major complications related to mechanical and thermal damage may occur, especially in cases of tumors adjacent to extrahepatic organs and those at subcapsular position. This case report shows a successful RFA of two hepatic subcapsular leiomyosarcoma metastases neighbouring the gallbladder, without a safe cleavage plane from it. Combined hydrodissection, percutaneous cholecystostomy and continuous irrigation were performed as effective techniques to prevent thermal injury. Clinical and radiological follow up demonstrates no local complication.


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Magnetic Resonance Imaging, Computed Tomography, Ultrasound, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Percutaneous Transhepatic Embolization of Bleeding Rectal Varices Using A New Embolic And Sclerotic Mixture Augmented By Amplatzer Vascular Plug 2 by Ahmed Kamel Abdel-Aal et al.

Published: 2016 Sep
Issue: 10(9) :: Pages: 44-51


Free full text article: Percutaneous Transhepatic Embolization of Bleeding Rectal Varices Using A New Embolic And Sclerotic Mixture Augmented By Amplatzer Vascular Plug 2

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Abstract: We report a case of 59-year-old female with non-alcoholic-steato-hepatitis (NASH) induced cirrhosis, who presented with hematochezia. The patient had a history of bleeding esophageal varices treated with endoscopic variceal ligation (EVL). Colonoscopy showed large rectal varices which were the source of her lower gastrointestinal bleeding (LGIB). Since endoscopic treatment for LGIB are limited, and because the patient had portal vein thrombosis which contraindicated transjugular intrahepatic portosystemic shunt (TIPS), we performed percutaneous transhepatic embolization of her rectal varices using a new mixture of embolic and sclerotic agents, followed by Amplatzer plug 2 (AVP 2). To our knowledge, the use of this new mixture with the AVP 2 in the rectal varices treatment has not been previously published in literature. Our case provides an alternative treatment modality that can be used for rectal varices treatment, when TIPS and endoscopic management fails or is contraindicated.


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Computed Tomography, Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Percutaneous Retrieval of an Embolized Kyphoplasty Cement Fragment From the Pulmonary Artery: A Case Report and Literature Review by Nicole A. Lamparello et al.

Published: 2016 Jul
Issue: 10(7) :: Pages: 40-47


Free full text article: Percutaneous Retrieval of an Embolized Kyphoplasty Cement Fragment From the Pulmonary Artery: A Case Report and Literature Review

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Abstract: We present a case of a 41-year-old man with symptomatic pulmonary cement embolism following percutaneous vertebral augmentation, which was successfully retrieved via a percutaneous endovascular approach, a novel technique with only two prior cases reported. Cement leakage, including venous embolization of cement into the cardiopulmonary circulation, is a known potential complication following percutaneous kyphoplasty and vertebroplasty. While many patients with pulmonary cement embolism are asymptomatic and likely go undiagnosed, others experience respiratory distress and hemodynamic compromise requiring surgical and medical intervention. The optimal management for pulmonary cement embolism must be tailored to fit each individual patient, dependent upon the acuity of the clinical presentation, coexisting patient comorbidities, and the risks of systemic anticoagulation. In our patient, cement migration was visualized in real-time during vertebral augmentation. Endovascular retrieval by our Interventional Radiology section obviated the need for anticoagulation therapy or more invasive open surgical procedures.


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Nuclear Medicine, Fluoroscopy, Computed Tomography, Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Treatment of Hypersplenism by Partial Splenic Embolization Through Gastric Collaterals by Souheil Saddekni et al.

Published: 2016 Mar
Issue: 10(3) :: Pages: 28-35


Free full text article: Treatment of Hypersplenism by Partial Splenic Embolization Through Gastric Collaterals

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Abstract: We report a case of Chronic lymphocytic leukemia (CLL) with associated hypersplenism, that was referred to us for partial splenic embolization (PSE) as the patient was not a surgical candidate for splenectomy. Initially, we were not successful in catheterizing the splenic artery from the celiac trunk due to significant atherosclerotic disease. Therefore, we successfully managed to access the distal splenic artery through patent gastro-epiploic collateral circulation along the greater curvature of the stomach. Partial splenic embolization was successfully performed and resulted in improvement of the patient`s peripheral blood cell count as well as 60-70% reduction in the size of the spleen on follow up. Our case highlights an alternative pathway for splenic artery embolization when catheterization of the splenic artery is not feasible. To our knowledge, the use of gastro-epiploic collaterals to embolize the spleen has not been previously reported in literature.


Available image modalities: (click on modality to browse for other articles)
Computed Tomography, Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Percutaneous Approach for Removal of a Migrated Cystogastric Stent from a Pancreatic Pseudocyst: A Case Report and Review of the Literature by Al-Shehri Shaker et al.

Published: 2016 Feb
Issue: 10(2) :: Pages: 18-25


Free full text article: Percutaneous Approach for Removal of a Migrated Cystogastric Stent from a Pancreatic Pseudocyst:  A Case Report and Review of the Literature

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Abstract: Stent migration into pancreatic pseudocysts during endosonographic (EUS) cystogastrostomy is a relatively rare complication. The migrated stent may induce, if it remains within the body, infection and perforation. Therefore, retrieval and/or re-stenting is necessary. Endoscopic retrieval is commonly attempted first. However, it is technically challenging and largely dependent on the skill of the endoscopists; if retrieval is unsuccessful, surgery is usually carried out. We report a case of stent migration into a pancreatic pseudocyst that was retrieved with a percutaneous approach under imaging guidance using a simple technique with available devices. A technique that enhances the role of interventional radiology in the management of this rare complication.


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Ultrasound, Computed Tomography, Fluoroscopy, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm by Alberto Rebonato et al.

Published: 2016 Feb
Issue: 10(2) :: Pages: 26-32


Free full text article: Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm

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Abstract: We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare.


Available image modalities: (click on modality to browse for other articles)
Computed Tomography, Angiography, Interventional, Clinical image, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Extensive Erosion of Vertebral Bodies Due to a Chronic Contained Ruptured Abdominal Aortic Aneurysm by Alecio Fernando Lombardi et al.

Published: 2016 Jan
Issue: 10(1) :: Pages: 27-34


Free full text article: Extensive Erosion of Vertebral Bodies Due to a Chronic Contained Ruptured Abdominal Aortic Aneurysm

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Abstract: This report describes a case of chronically ruptured abdominal aortic aneurysm contained within the lumbar vertebral bodies that presented with dull abdominal pain. Sudden, massive hemorrhage is an uncommon, yet well-known complication of an untreated abdominal aortic aneurysm. In addition, misleading clinical and radiological findings present difficult diagnostic challenges in such cases. This report emphasizes the findings obtained with multidetector computed tomography and delineates the differentiation of this condition from similar pathologies.


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Computed Tomography, Magnetic Resonance Imaging, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury by Ahmed Kamel Abdel-Aal et al.

Published: 2015 Dec
Issue: 9(12) :: Pages: 37-43


Free full text article: Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury

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Abstract: We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple`s pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure.


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Computed Tomography, Angiography, Interventional, Nuclear Medicine, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Aberrant systemic arterial supply to normal lung arising from the proper hepatic artery discovered during transarterial chemoembolization by Matthew K Walsworth et al.

Published: 2015 Nov
Issue: 9(11) :: Pages: 24-31


Free full text article: Aberrant systemic arterial supply to normal lung arising from the proper hepatic artery discovered during transarterial chemoembolization

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Abstract: We report a rare case of dual arterial supply to an otherwise normal lung discovered incidentally during initial angiography performed with the intent of chemoembolization of hepatocellular carcinoma. In addition to normal hepatic arterial supply, the proper hepatic artery provided systemic arterial supply to the lower lobe of the left lung. Subsequent chest computed tomography angiography demonstrated a normal tracheobronchial tree and normal pulmonary arterial supply to the lung. Although other anatomic variants have been reported, there are no other reported cases of systemic arterial supply from the proper hepatic artery to the lung. Identifying systemic arterial supply to the lung during angiography is important while performing transcatheter chemoembolization or radioembolization in the liver in order to minimize non-target embolization of the lung.


Available image modalities: (click on modality to browse for other articles)
Angiography, Interventional, Computed Tomography, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience by Jason Salsamendi et al.

Published: 2015 Oct
Issue: 9(10) :: Pages: 9-17


Free full text article: Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience

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Abstract: Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt–Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment.


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Angiography, Interventional, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Minimally invasive percutaneous endovascular therapies in the management of complications of non-alcoholic fatty liver disease (NAFLD): A case report by Jason Salsamendi et al.

Published: 2015 Sep
Issue: 9(9) :: Pages: 36-43


Free full text article: Minimally invasive percutaneous endovascular therapies in the management of complications of non-alcoholic fatty liver disease (NAFLD):  A case report

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Abstract: Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disorders from simple steatosis to inflammation leading to fibrosis, cirrhosis, and even hepatocellular carcinoma. With the progressive epidemics of obesity and diabetes, major risk factors in the development and pathogenesis of NAFLD, the prevalence of NAFLD and its associated complications including liver failure and hepatocellular carcinoma is expected to increase by 2030 with an enormous health and economic impact. We present a patient who developed Hepatocellular carcinoma (HCC) from nonalcoholic steatohepatitis (NASH) cirrhosis. Due to morbid obesity, she was not an optimal transplant candidate and was not initially listed. After attempts for lifestyle modifications failed to lead to weight reduction, a transarterial embolization of the left gastric artery was performed. This is the sixth such procedure in humans in literature. Subsequently she had a meaningful drop in BMI from 42 to 36 over the following 6 months ultimately leading to her being listed for transplant. During this time, the left hepatic HCC was treated with chemoembolization without evidence of recurrence. In this article, we wish to highlight the use of minimally invasive percutaneous endovascular therapies such as transarterial chemoembolization (TACE) in the comprehensive management of the NAFLD spectrum and percutaneous transarterial embolization of the left gastric artery (LGA), a novel method, for the management of obesity.


Available image modalities: (click on modality to browse for other articles)
Magnetic Resonance Imaging, Angiography, Interventional, Graph, Table





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Role of bilateral inferior petrosal sinus sampling (BIPSS) in the diagnosis of Cushing`s disease in a patient with double superior vena cava by Sonam Tashi et al.

Published: 2015 Aug
Issue: 9(8) :: Pages: 24-32


Free full text article: Role of bilateral inferior petrosal sinus sampling (BIPSS) in the diagnosis of Cushing`s disease in a patient with double superior vena cava

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Abstract: Cushing`s syndrome is known to have a wide spectrum of clinical presentation with debilitating consequences and morbidity if not diagnosed and treated in time. Sometimes the diagnosis of Cushing`s syndrome can be challenging to the endocrinologist, especially when the usual battery of biochemical tests and advanced cross-sectional imaging is negative or inconclusive. We described a case in which the use of bilateral inferior petrosal sinus sampling (BIPSS) was conclusive albeit being technically challenging (due to a rare incidental finding of double superior vena cava) and invasive in nature.


Available image modalities: (click on modality to browse for other articles)
Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Popliteal vein aneurysm presenting as recurrent pulmonary embolism by Joel Lim et al.

Published: 2015 Apr
Issue: 9(4) :: Pages: 23-27


Free full text article: Popliteal vein aneurysm presenting as recurrent pulmonary embolism

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Abstract: Although rare, popliteal vein aneurysms can lead to pulmonary emboli, which can be fatal. We present a case of a popliteal vein aneurysm in a 39-year-old female who presented with her third episode of pulmonary embolism despite being on anticoagulants. Computed Tomography Venogram demonstrated a large Popliteal Vein Aneurysm measuring 71 x 36 x 77 mm which was surgically repaired. According to the current literature, anticoagulation is insufficient therefore early surgical intervention is recommended as it is safe and effective.


Available image modalities: (click on modality to browse for other articles)
Computed Tomography, Ultrasound, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Chronic innominate artery occlusion with hyperacute intracranial thromboembolism: Revascularization with simultaneous local thromboaspiration and mechanical thrombectomy by Ajeet Gordhan et al.

Published: 2015 Mar
Issue: 9(3) :: Pages: 27-36


Free full text article: Chronic innominate artery occlusion with hyperacute intracranial thromboembolism: Revascularization with simultaneous local thromboaspiration and mechanical thrombectomy

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Abstract: Chronic innominate artery occlusion with acute right internal carotid terminus thromboembolism and successful revascularization using simultaneous local thromboaspiration and mechanical thrombectomy has not been previously described. A 51-year-old male presented with transient left hemiparesis. A CT angiogram of the head and neck demonstrated chronic occlusion of the right innominate artery with no intracranial thromboembolism. More profound symptoms recurred twelve hours after admission. A diagnostic catheter-based angiogram confirmed occlusion of the innominate artery and identified hyper-acute right carotid terminus thromboembolism. Angioplasty of the innominate artery was followed by simultaneous mechanical and aspiration thrombectomy of the right internal carotid artery terminus. Combination local thromboaspiration and mechanical thrombectomy was shown in this case to be effective in achieving a favorable clinical outcome.


Available image modalities: (click on modality to browse for other articles)
Magnetic Resonance Imaging, Computed Tomography, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Seeding of the Rectus Sheath with Hepatocellular Carcinoma after Image Guided Percutaneous Liver Biopsy Using Coaxial Biopsy Needle System by Vladislav V. Tchatalbachev et al.

Published: 2015 Jan
Issue: 9(1) :: Pages: 18-25


Free full text article: Seeding of the Rectus Sheath with Hepatocellular Carcinoma after Image Guided Percutaneous Liver Biopsy Using Coaxial Biopsy Needle System

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Abstract: Needle track seeding following image guided needle biopsy is a known but uncommon complication in the workup of hepatocellular carcinoma. We present the case of a 55 year-old male who was found to have a recurrent hepatocellular carcinoma in the rectus sheath five years following a CT guided biopsy with the biopsy needle passing through the anterior abdominal wall muscles.


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Computed Tomography, Microscopic pathology, Magnetic Resonance Imaging, Macroscopic pathology, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Visceral artery embolization after endoscopic injection of Enteryx for gastroesophageal reflux disease by Naseem Helo et al.

Published: 2014 Sep
Issue: 8(9) :: Pages: 21-24


Free full text article: Visceral artery embolization after endoscopic injection of Enteryx for gastroesophageal reflux disease

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Abstract: Gastroesophageal reflux disease (GERD) can be difficult to manage medically and may require endoscopic or surgical interventions. The Enteryx procedure was designed to enhance the gastroesophageal barrier function by endoscopic injection of a copolymer into the lower esophageal sphincter. We present a rare case of a patient who was found to have migration of the copolymer into the celiac trunk and bilateral renal arteries during a work-up for persistent intermittent hematuria, which began shortly after Enteryx therapy for GERD.


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Conventional Radiography, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings by Christopher Bolus et al.

Published: 2014 Aug
Issue: 8(8) :: Pages: 33-42


Free full text article: Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx:  A Case Report and Review of the Differential Diagnosis Imaging Findings

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Abstract: Hepatic arteriovenous malformations are rare congenital lesions associated with significant morbidity and mortality, most commonly from high output cardiac failure. Efficient diagnosis and treatment demands an interdisciplinary approach, and the interventional radiologist plays a pivotal role in both. Imaging is important for diagnostic accuracy and treatment planning, and transcatheter embolization has become an established primary therapy. We report the clinical and imaging findings of a rare hepatic arteriovenous malformation in an infant presenting with high-output cardiac failure and pulmonary artery hypertension that was successfully treated by transarterial embolization using Onyx.


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Conventional Radiography, Ultrasound, Magnetic Resonance Imaging, Clinical image, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Endovascular Management of Ureteroarterial Fistula: A Rare Potentially Life Threatening Cause of Hematuria by Alexander Copelan et al.

Published: 2014 Jul
Issue: 8(7) :: Pages: 37-45


Free full text article: Endovascular Management of Ureteroarterial Fistula: A Rare Potentially Life Threatening Cause of Hematuria

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Abstract: Ureteroarterial fistula is a rare, potentially life-threatening cause of hematuria characterized by an abnormal channel between a ureter and artery. The rarity of this condition, complexity of predisposing risk factors and intermittence of symptoms may delay or obscure its diagnosis. With a high index of suspicion and careful angiographic evaluation, embarking on this condition is not only possible but sets the stage for curative intervention. We report a case of a ureteroarterial fistula presenting with intermittent hematuria, successfully diagnosed at angiography and managed with endovascular stent graft placement.


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Computed Tomography, Nuclear Medicine, Angiography, Interventional, Table





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Symptomatic Vertebral Artery Loop: A case report and review of literature by Ahmed Doweidar et al.

Published: 2014 May
Issue: 8(5) :: Pages: 35-41


Free full text article: Symptomatic Vertebral Artery Loop:  A case report and review of literature

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Abstract: Vertebral artery loop formation is a rare anatomical variant capable of causing bony erosion, encroachment on cervical neural foramen, neurovascular compression, or vertebrobasilar insufficiency. Health professionals should keep the diagnosis of vertebral artery loop formation in mind, especially when the plain radiograph of the cervical spine shows enlargement of the intervertebral foramen. If overlooked, serious complications like vertebral artery injury may occur during surgery or vertebrobasilar angiography, as well as cerebrovascular stroke during transforaminal cervical epidural steroid injections. This case report aims at increasing the awareness of both clinicians and radiologists of this entity as a known rare cause of cervical radiculopathy. In suspected cases, Magnetic resonance imaging & Magnetic resonance angiography should always be the first choice in this regard.


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Computed Tomography, Magnetic Resonance Imaging, Table

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Diagnosis of pancreatic duct-portal vein fistula; a case report and review of the literature by Anthony Brown et al.

Published: 2014 Mar
Issue: 8(3) :: Pages: 31-38


Free full text article: Diagnosis of pancreatic duct-portal vein fistula;  a case report and review of the literature

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Abstract: Pseudocysts containing activated enzymes are a common complication of pancreatitis. Pseudocysts can rupture into adjacent structures including the peritoneal cavity, adjacent organs, and rarely vascular structures. While arterial pseudoaneurysms and venous thrombosis or occlusion are well known complications of acute and chronic pancreatitis, only 17 cases of pancreas-portal venous fistula have been encountered in review of the literature. A patient with chronic pancreatitis presented with a history of weight loss, fatigue and was found to have a pancreatic duct-portal vein fistula. The patient was treated surgically with good outcome.


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Computed Tomography, Fluoroscopy, Magnetic Resonance Imaging, Macroscopic pathology, Table

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Spontaneous Portoazygos Shunt in a Patient with Portal Hypertension by Jacob Gebrael et al.

Published: 2013 Jul
Issue: 7(7) :: Pages: 32-36


Free full text article: Spontaneous Portoazygos Shunt in a Patient with Portal Hypertension

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Abstract: We present a case of spontaneous portoazygos shunt in a patient with liver cirrhosis and portal hypertension. The shunt was incidentally detected by abdominal magnetic resonance imaging for routine evaluation of liver cirrhosis. Multiplanar reconstruction images demonstrated the portal vein communicating with the azygos vein that was dilated and tortuous along its course to the mediastinum. Although there has been a case of congenital portoazygos shunt reported in a neonate with multiple congenital anomalies, to the best of our knowledge, this is the first case of spontaneous portoazygos shunt developed in an adult with portal hypertension.


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Magnetic Resonance Imaging, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Post-Pancreaticoduodenectomy Hemorrhage of Unusual Origin: Treatment with Endovascular Embolization and the value of preoperative CT Angiography by Kortney Robinson et al.

Published: 2013 Apr
Issue: 7(4) :: Pages: 29-36


Free full text article: Post-Pancreaticoduodenectomy Hemorrhage of Unusual Origin: Treatment with Endovascular Embolization and the value of preoperative CT Angiography

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Abstract: Post-pancreaticoduodenectomy hemorrhage is a life threatening complication reported to occur in 2-7% of patients. Historically, treatment required an exploratory laparotomy. Introduction of endovascular embolization has broadened the available treatment options. The most common location for a post-pancreaticoduodenectomy hemorrhage is the gastroduodenal artery stump. Nonetheless, unusual sources of hemorrhage exist and are hard to localize, thus they are often treated with open surgery. Here we report two cases of CTA proven hemorrhage from the dorsal pancreatic arcade and transverse pancreatic artery, which were successfully located with conventional angiography and treated with endovascular arterial coil embolization. Both patients were status post-pancreaticoduodenectomy (Whipple procedure) and presented with a sentinel bleed and a drop in hematocrit levels.


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Computed Tomography, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review by Miriam Klauß et al.

Published: 2012 Feb
Issue: 6(2) :: Pages: 9-16


Free full text article: Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review

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Abstract: We report a case of an uncommon giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis. It presented with a perfused volume of 17.3 cm³ close to the branch-off of the right hepatic artery. Superselective transcatheter embolization including interlocking detachable coils and a mixture of Ethibloc and Lipiodol was our technique of choice. Following the procedure, the patient was in hemodynamically stable condition. At that time, he was free of any clinical symptoms and showed no further signs of bleeding or ischaemia. Additionally, we present an overview of the relevant literature.


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Computed Tomography, Angiography, Interventional, Graph, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Endovascular Stent Graft for Post-traumatic Superficial Femoral Artery Pseudoaneurysms with Arteriovenous Fistula: 6 Months Follow-Up of 2 Cases by Jawahar Rajusingh Rathod et al.

Published: 2011 Nov
Issue: 5(11) :: Pages: 26-34


Free full text article: Endovascular Stent Graft for Post-traumatic Superficial Femoral Artery Pseudoaneurysms with Arteriovenous Fistula: 6 Months Follow-Up of 2 Cases

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Abstract: Pseudoaneurysms are common vascular abnormalities due to disruption of the vessel wall. Pseudoaneurysm with arteriovenous fistula is a rare presentation. Complications associated with them develop unpredictably and carry a high mortality rate. Traditionally pseudoaneurysms have been treated surgically. However, with the advent of new interventional techniques, management using endovascular approach have gained popularity in treating pseudoaneurysms. Here, we present two cases of large pseudoaneurysms with arteriovenous fistula treated by percutaneous stent graft. Present studies on pseudoaneurysms are all either iatrogenic or secondary to nephrologic dialysis treatment and only few present studies exist describing such large post-traumatic femoral pseudoaneurysms with arteriovenous fistulas were treated successfully by stent grafting through femoral approach, with good patency at 6 months follow up.


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Ultrasound, Angiography, Interventional, Clinical image, Magnetic Resonance Imaging, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty by David Leitman et al.

Published: 2011 Oct
Issue: 5(10) :: Pages: 14-21


Free full text article: Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty

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Abstract: Percutaneous vertebroplasty (PV) is a procedure commonly used for the treatment of vertebral compression fractures, and the number of procedures has been steadily increasing over the past decade. We report a case of an 81 year old female with a history of breast cancer that developed two vertebral body compression fractures and was subsequently treated with PV. The patient developed a subsegmental pulmonary polymethylmethacrylate (PMMA) embolus as a complication of the procedure. Ten years following the procedure, she remained asymptomatic with the PMMA embolus being discovered incidentally during workup for a suspected chronic obstructive pulmonary disease (COPD) exacerbation. In reviewing the case, we describe the typical presentation of a pulmonary PMMA embolus and consider methods to decrease the incidence of this complication.


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Conventional Radiography, Fluoroscopy, Computed Tomography, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Rescue from hemodialysis by late recanalization of renal artery occlusion by Kristina Imeen Ringe et al.

Published: 2011 May
Issue: 5(5) :: Pages: 19-23


Free full text article: Rescue from hemodialysis by late recanalization of renal artery occlusion

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Abstract: We report on a patient with terminal renal insufficiency undergoing hemodialysis since four months. Imaging studies showed complete renal artery occlusion of a single kidney with collateral perfusion. Interventional recanalization of the renal artery was successful with a drop of serum creatinine from 1138 to 163 mol/l sparing the patient from further hemodialysis.


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Computed Tomography, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Alcohol sclerosis of a giant liver cyst following failed deroofings by Adib R. Karam*¹, Caitlin Connolly², Urvi Fulwadhva¹, Sarwat Hussain¹ et al.

Published: 2011 Feb
Issue: 5(2) :: Pages: 19-22


Free full text article: Alcohol sclerosis of a giant liver cyst following failed deroofings

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Abstract: Percutaneous alcohol sclerotherapy for simple liver cysts is an established and safe procedure. We report alcohol ablation of a very large (5.5 liters) liver cyst that had failed laparoscopic deroofing procedures twice. The cyst responded to multisession alcohol sclerotherapy.


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Computed Tomography, Angiography, Interventional, Table

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Sinistral Portal Hypertension: Presentation, Radiological Findings, and Treatment Options - A Case Report by Nima Kokabi et al.

Published: 2010 Oct
Issue: 4(10) :: Pages: 14-20


Free full text article: Sinistral Portal Hypertension: Presentation, Radiological Findings, and Treatment Options - A Case Report

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Abstract: Sinistral portal hypertension occurs when a pathological process causes occlusion of the splenic vein. The resultant elevated splenic bed venous pressure causes formation of gastric varices which can lead to hematemesis as a common presentation for this disease process. We present a case of sinistral portal hypertension in a patient with acute hematemesis as the primary presentation. Despite the challenging diagnosis process, the patient underwent splenectomy and was managed appropriately according to previously published literature.


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Computed Tomography, Angiography, Interventional, Table

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Transmural Coil Extrusion After Embolization for Colonic Hemorrhage by Richard Duszak et al.

Published: 2010 Sep
Issue: 4(9) :: Pages: 31-36


Free full text article: Transmural Coil Extrusion After Embolization for Colonic Hemorrhage

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Abstract: Transcatheter embolization is increasingly accepted as a safe and effective therapy for acute lower gastrointestinal hemorrhage, but the fate of the coils used for treatment is not entirely known. We report a patient with massive descending colonic bleeding, successfully treated with microcoil occlusion, in whom partially extruded coils were later visualized colonoscopically, but initially misidentified as ingested jewelry. The incidence of this endoscopically enigmatic (but in this case clinically inconsequential) finding is unknown.


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Angiography, Interventional, Clinical image, Table





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Combined percutaneous and endoscopic approach in management of dropped gallstones following laparoscopic cholecystectomy by John S.F. Shum et al.

Published: 2010 Jul
Issue: 4(7) :: Pages: 1-5


Free full text article: Combined percutaneous and endoscopic approach in management of dropped gallstones following laparoscopic cholecystectomy

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Abstract: Dropped gallstones due to accidental perforation of gallbladder wall during laparoscopic cholecystectomy are often encountered. However, dropped gallstones as nidus of infection with subsequent abscess formation is a rare complication of laparoscopic cholecystectomy (0.3%). Most of the reported cases of complicated dropped stones required open surgical drainage. Minimally invasive measures were less frequently employed. We report a case of dropped gallstones that were removed endoscopically through a percutaneous drainage tract.


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Computed Tomography, Fluoroscopy, Clinical image

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Percutaneous transrenal retrieval of fractured nephrostomy tube under fluoroscopic guidance by Adib R. Karam et al.

Published: 2010 May
Issue: 4(5) :: Pages: 41-45


Free full text article: Percutaneous transrenal retrieval of fractured nephrostomy tube under fluoroscopic guidance

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Abstract: Percutaneous nephrostomy is a safe procedure, performed routinely by interventional radiologists, and has a low complication rate. We report an unusual case of a fractured nephrostomy tube, retained within the kidney, having its fractured end trapped within the healed retroperitoneal tract. The catheter was retrieved by snaring it, using a percutaneous access to the collecting system. We describe the technique used and the alternative management options.


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Angiography, Interventional, Computed Tomography

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Spontaneous celiac artery dissection and its management by Sandeep Vaidya et al.

Published: 2010 Apr
Issue: 4(4) :: Pages: 30-33


Free full text article: Spontaneous celiac artery dissection and its management

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Abstract: Spontaneous visceral artery dissection is an uncommon event with an unpredictable natural history with superior mesenteric artery being the most common affected artery. It is most often asymptomatic and usually diagnosed at autopsy. Pre-disposing factors are not specific but have been suggested to be pre-existing vascular disease, hypertension and pregnancy. Spontaneous resolution, definitive occlusion of the artery, and formation of an aneurysm with associated complications are some other possible outcomes. Isolated dissection of the celiac artery (CA) is rare and there are only a few cases reported in the literature. We present a case of a 65 year old male with spontaneous celiac artery dissection and provide a review of the current literature about imaging findings and management of this entity.


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Computed Tomography

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Stent-assisted coil embolization of a wide-necked renal artery aneurysm by Bjoern Kitzing et al.

Published: 2010 Apr
Issue: 4(4) :: Pages: 20-24


Free full text article: Stent-assisted coil embolization of a wide-necked renal artery aneurysm

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Abstract: We present a case of stent-assisted coil embolization of a wide-necked renal artery aneurysm performed at our institution. The technique involved a stent being delivered over the neck of the aneurysm. Subsequently a catheter was placed into the aneurysm through the stent mesh and the aneurysm was then filled with detachable coils. Complete aneurysm occlusion was obtained and there was no evidence to suggest renal infarction on a follow-up contrast CT scan 6 months later. Our preliminary experience suggests that stent-assisted coil embolization of wide-necked renal artery aneurysms is a technically challenging but potentially effective renal-sparing endovascular approach.


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Computed Tomography, Angiography, Interventional

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Utility of aortic cuffs in converting initially ineligible patients due to unfavorable neck anatomy into successful candidates for endovascular aortic aneurysm repair: A Case Series by Omer Awan et al.

Published: 2010 Mar
Issue: 4(3) :: Pages: 1-10


Free full text article: Utility of aortic cuffs in converting initially ineligible patients due to unfavorable neck anatomy into successful candidates for endovascular aortic aneurysm repair: A Case Series

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Abstract: Endovascular repair of the abdominal aortic aneurysm has been established as a successful alternative to open surgical repair, provided that the criteria necessary for such an approach are fulfilled. Anatomic criteria include suitable diameter, length, and angle of the aneurysm proximal neck. We present three cases in which patients were initially ineligible for endovascular repair because of unfavorable neck anatomy but in whom the use of aortic cuffs allowed for successful endograft placement and aneurysm exclusion.


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Graph, Computed Tomography, Angiography, Interventional

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Successful Transcatheter Arterial Embolisation of a Cystic Artery Pseudoaneurysm Secondary to Calculus Cholecystitis: A Case Report by Amidevi U. Desai et al.

Published: 2010 Feb
Issue: 4(2) :: Pages: 18-22


Free full text article: Successful Transcatheter Arterial Embolisation of a Cystic Artery Pseudoaneurysm Secondary to Calculus Cholecystitis: A Case Report

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Abstract: Pseudoaneurysms of the cystic artery secondary to calculus cholecystitis are rare. In this report we describe a case of an elderly female who presented with abdominal pain, pyrexia, anaemia and jaundice. She had known chronic cholecystitis, but was not considered a suitable surgical candidate. Contrast enhanced computed tomography (CECT) demonstrated a probable aneurysm within the gallbladder fossa. The patient proceeded to digital subtraction angiography (DSA), which confirmed an aneurysm arising from the cystic artery and was subsequently managed with transcatheter arterial embolisation using coils. This case report reviews the diagnosis and management of this rare complication.


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Ultrasound, Computed Tomography, Angiography, Interventional

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Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report by Alex Mortimer et al.

Published: 2009 Jun
Issue: 3(6) :: Pages: 9-15


Free full text article: Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

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Abstract: Vertebro-vertebral arteriovenous fistulae occur infrequently. We report on such a case with delayed presentation following penetrating neck injury. This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right. She had sustained penetrating neck trauma 6 months earlier. Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula. Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed.


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Computed Tomography, Magnetic Resonance Imaging, Angiography, Interventional

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Other Radiology articles from the Interventional Radiology section Interventional Radiology

Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature by A Shaw et al.

Published: 2009 Mar
Issue: 3(3) :: Pages: 12-16


Free full text article: Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature

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Abstract: Arterial pseudoaneurysm formation of the genicular vessels following orthopaedic surgery to the knee is an extremely rare occurrence. Here we report the successful management of two cases as a complication of total knee arthroplasty and a tibial interlocking nail, utilising coil embolisation by interventional radiological techniques and negating the need for further surgery. To our knowledge this is one of the few reported cases of pseudoaneurysms of the descending genicular artery secondary to drain placement and only the second following tibial interlocking nail placement.


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Conventional Radiography, Fluoroscopy





Other Radiology articles from the Interventional Radiology section Interventional Radiology

Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava by Marc Gingell Littlejohn et al.

Published: 2009 Jan
Issue: 3(1) :: Pages: 3-6


Free full text article: Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava

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Abstract: We present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA) and the inferior vena cava (IVC), successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ) obstruction and recurrent pyelonephritis. It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.


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Angiography, Interventional





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Irinotecan drug eluting beads used as a treatment of advanced intra hepatic cholangiocarcinoma by Jean Amede Roch et al.

Published: 2008 Oct
Issue: 2(4) :: Pages: 24-27


Free full text article: Irinotecan drug eluting beads used as a treatment of advanced intra hepatic cholangiocarcinoma

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Abstract: This report describes a 74-year-old male with unresectable intrahepatic cholangiocarcinoma (ICC). However surgical procedure is the only curative treatment, it often seems to be ineffective because of the aggressive behaviour of the disease. The role of systemic chemotherapy in the ICC is undefined with a median survival between 6.43 to 12.17 months obtained by using the combination chemotherapy of gemcitabine with cisplatin. In the present case, we performed a targeted treatment using drug eluting beads (DEB) with irinotecan (IRI) administered as transarterial-chemoembolization (TACE). After one session, the tumour vascularity decreased significantly at the one month evaluation on computed tomography (CT) scan of the liver. This case report suggested that minimally invasive transcatheter DEB embolization could be a promising, safe and effective treatment for selective patients with unresectable ICC.


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Ultrasound, Computed Tomography, Angiography, Interventional

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